1. Field of the Invention
This invention relates to medical instruments and procedures and, more particularly, to a medical device that can be used to assist the performance of an internal medical procedure and/or the closing of a tissue opening and a method of using this device.
2. Background Art
Many of the procedures performed by open laparotomy are currently performed by operative laparoscopy. With increased applications of advanced operative laparoscopy, surgeons are experiencing an increased incidence of herniations through laparoscopy sleeved cannula sites. To prevent this complication there is a developing consensus to close the surgical defect associated with the insertion of laparoscopy cannulas 10 mm or greater in outside diameter. Although rare, sliding hernias have been reported with 5 mm laparoscopy cannulas.
Numerous needles and other devices have been developed to accomplish full thickness closure of the abdominal wall at the operative site of cannula insertion. However, the use of such devices has been associated with a certain degree of difficulty. If the device is used while the cannula is still in place, it is cumbersome to introduce the device between the cannula and the skin, because the cannula is tightly apposed to the skin margins of the incision. This is done to penetrate the abdominal wall excluding the skin. Furthermore, obtaining a suitable tissue purchase i.e. further away from the edge of the fascial defect, is technically difficult. On the other hand, if the cannula is tilted within the incision to improve access to the deeper layers of the abdominal wall, the pneumoperitoneum gas escapes rapidly through the less than tight application. Loss of the pneumoperitoneum gas makes the process of penetrating the abdominal wall with a sharp object extremely dangerous; because the bowel becomes quickly situated immediately under the abdominal wall. Therefore, this process has to be accomplished very quickly, without regard to accurate device placement within the abdominal wall.
If the closing device is applied after the laparoscopy cannula has been removed, the pneumoperitoneum gas escapes very rapidly through the open incision precluding any chance of a full thickness closure. Therefore, a device with a plug must be used to seal the incision and maintain the pneumoperitoneum while placing the full-thickness closing sutures.